APPLICATION FORM FOR RATION CARD 1. Details address of household. a. Present Ward No. b. Plot No. c. Qrs. No. d. Location of residence e. Holding No. 2. Municipality ­ 3. District ­ 4. Name of the house owner (it is rented house). 5. Reference of Old Ration Card. a. Card No. b. Sl. No. c. Name of the Dealer i. Name and address of the head of the household. ii. Approximate age of the head of household. iii. Occupation of the head of the household. iv. Approximate monthly income of the household. v. Others member of the household. Sl. Name Approx Relationship No. age. With the The head of the household 1 2 3 4 5 6 7 8 Signature of the Head of the household ( In full) ENQUIRY REPORT FOR ISSUE OF RATION CARD Date of Visit : 1. Name of the Applicant : 2. Place of residence : a) Name of the ward : b) Plot No. Quatter's No. : c) Holding No. : d) Area : 3. Whether own house or a rented one : 4. Name of the house owner if it is a rented one : 5. Monthly Income : 6. Profession Occupation : 7. Name of the other Family members : Name Age Relationship with the household i) ii) iii) iv) v) 8. Whether applied residence was covered during the last enumeration or not? If not then reason thereof ? 9. Name of the previous occupant H I S R.C. No. & Retail tagged. 10. How in the applicant is in the Bhubaneswar city? State the previous place residence where he has residing earlier. 11. State the name of other households if residing in the same holding with R.C. numbers. 12. Specific Views of Inquiring Officer. PLACE SIGNATURE OF THE DATE INSPECTOR OF SUPPLIES.